937. Appropriateness of using a Mobile Application for Choosing Antibiotic Therapy in Hospitalized Patients at Siriraj Hospital

Abstract Background Development of facility-specific clinical practice guidelines and incorporation of computerized clinical decision support have been recommended as the effective antimicrobial stewardship strategies. The DigitalAMSTM is a mobile-based application used to guide choosing empirical antibiotics. Before the hospital-wide implementation of DigitalAMSTM, the appropriateness and limitation of such an application needs to be evaluated. Methods A retrospective cross-sectional study of hospitalized adult patients who received at least one dose of antibiotic and had at least one documented site of infection were enrolled between 1 Jan and 31 Jun 2018. All necessary data was obtained via chart review. The antibiotic regimen that was prescribed by the ward physician (WARD), the regimen recommended by the DigitalAMSTM (APP), the regimen recommended by the independent infectious disease (ID) physicians before and after knowing the culture results (Emp-ID and Def-ID) were compared. Results A total of 401 patients of the targeted infections i.e. 98 subjects with pneumonia, 103 subjects with urinary tract infection (UTI), 98 subjects with bacteremia and 102 subjects with skin and soft tissue infection (SSTI) were enrolled. The percent agreement between the APP and the WARD was less than half in all sites of infection. The APP regimen provided approximately 80% agreement with the Emp-ID regimen among subjects with UTI (78.6%), bacteremia (85.7%) and SSSI (85.2%), while the percent agreement of the WARD regimen and the Emp-ID was approximately half in all sites of infection. The lowest percent agreement between the APP regimen and the Emp-ID regimen was found among subjects with pneumonia (59.1%). Univariate analysis did not reveal any association between subjects who received the antibiotic regimen matching to the APP recommendation and the 28-day mortality. Conclusion Our study confirmed that the DigitalAMSTM application could improve appropriateness of antibiotic regimens for empirical therapy for four common infections among adult hospitalized patients at Siriraj Hospital. However, some revisions need to be done to improve the appropriateness of antibiotic regimens in the APP, especially for subjects with pneumonia. Disclosures All Authors: No reported disclosures.